Medically assisted hydration for adults receiving palliative care

Buchan, Emma J; Haywood, Alison; Syrmis, William; Good, Phillip

doi:10.1002/14651858.cd006273.pub4

Cited by 2 publications

(2 citation statements)

References 54 publications

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“…Internationally, about half of all deaths occur in hospitals [ 23 ], which is much higher than in Sweden. With respect to data on PF for dying persons with cancer, most controlled studies are performed in inpatient care according to Cochrane [ 7 ], therefore more studies are needed as regards other places of death. Notably, in the SRPC, specialized palliative care inpatient units are not classified as hospitals.…”

Section: Discussionmentioning

confidence: 99%

“…Parenteral fluid (PF) therapy in the imminently dying is controversial and whereas patients and families generally are positive, the view among staff varies, with 12-88% of cancer patients receiving PF during their last week of life [ 4 , 5 ]. It may have a role in a few selected patients who are distressed from severe dehydration, e.g., have symptoms suspected to be caused by hypercalcaemia, or suffer from severe confusion or terminal restlessness, although there is a general lack of evidence to support PF in the last days of life [ 6 , 7 ]. On the other hand, PF may prolong suffering and lead to unnecessary medicalization of the natural dying process, despite not ameliorating, or, possibly even aggravating EOL symptoms [ 8 – 10 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Fluid therapy is associated with lower care quality and higher symptom burden during last days of life of patients with cancer – a population-based register study

Lindskog,

Mogensen,

Tavelin

et al. 2024

BMC Palliat Care

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Background Parenteral fluid (PF) therapy of patients in end-of-life (EOL) is controversial. The purpose of this study was to assess associations between PF, quality of the EOL care process and symptom burden in dying cancer patients, using a population-based approach. Methods This was a nationwide retrospective register study of all adult cancer deaths with documented information on PF in the last 24 h of life as reported to the Swedish Register of Palliative Care during a three-year period (n = 41,709). Prevalence and relief of symptoms during the last week of life as well as EOL care process quality indicators were assessed in relation to PF in those patients who had a documented decision to focus on EOL care (immediately dying, n = 23,112). Odds ratios were calculated, adjusting for place of death (hospital vs. non-hospital). Results PF was administered to 30.9% of immediately dying patients in hospitals compared to 6.5% outside of hospitals. PF was associated with a higher likelihood for breathlessness and nausea. In patients screened for EOL symptoms with a validated instrument, PF was inversely associated with the likelihood of complete relief of breathlessness, respiratory secretions, anxiety, nausea and pain. Several palliative care quality indicators were inversely associated with PF, including EOL conversations and prescriptions of injectable drugs as needed. These associations were more pronounced in hospitals. Conclusions Parenteral fluid therapy in the last 24 h of life was associated with inferior quality of the EOL care process and with increased symptom burden in imminently dying cancer patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Fluid therapy is associated with lower care quality and higher symptom burden during last days of life of patients with cancer – a population-based register study

Lindskog,

Mogensen,

Tavelin

et al. 2024

BMC Palliat Care

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Multinational Association of Supportive Care in Cancer (MASCC) expert opinion/guidance on the use of clinically assisted hydration in patients with advanced cancer

Hayes,

Bruera,

Crawford

et al. 2024

Support Care Cancer

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Purpose The provision of clinically assisted hydration (CAH) in patients with advanced cancer is controversial, and there is a paucity of specific guidance and so a diversity in clinical practice. Consequently, the Palliative Care Study Group of the Multinational Association of Supportive Care in Cancer (MASCC) formed a sub-group to develop evidence-based guidance on the use of CAH in patients with advanced cancer. Methods This guidance was developed in accordance with the MASCC Guidelines Policy. A search strategy for Medline was developed, and the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials were explored for relevant reviews/trials, respectively. Results Due to the paucity of evidence, the sub-group was not able to develop a prescribed guideline, but was able to generate a number of “expert opinion statements”: these statements relate to assessment of patients, indications for CAH, contraindications for CAH, procedures for initiating CAH, and reassessment of patients. Conclusions This guidance provides a framework for the use of CAH in advanced cancer, although every patient requires individualised management.

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Medically assisted hydration for adults receiving palliative care

Cited by 2 publications

References 54 publications

Fluid therapy is associated with lower care quality and higher symptom burden during last days of life of patients with cancer – a population-based register study

Fluid therapy is associated with lower care quality and higher symptom burden during last days of life of patients with cancer – a population-based register study

Multinational Association of Supportive Care in Cancer (MASCC) expert opinion/guidance on the use of clinically assisted hydration in patients with advanced cancer

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